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Immigration, Nicolas Dupont-Aignan

State medical aid (Aide médicale de l'État): Abolish AME, one emergency clinic per département

Direction of change: abolition of a scheme, compared with current law.

The lever. Coverage of healthcare for foreign nationals in an irregular situation: maintained, reduced to emergencies or abolished. Direction rule: ↑ broader AME (State medical aid).

« Supprimer l’Aide Médicale d’État (AME) et mettre en place dans chaque département un dispensaire d’urgence pour les étrangers en situation irrégulière, avant leur expulsion. »1

Translation by the editorsAbolish State Medical Aid (AME) and set up in each département an emergency clinic for foreigners in an irregular situation, before their expulsion.

Encoding

Position linked to an option of the cost schedule, with no parameter to set: see the costing.

Costing

Announced by the candidate

+€5bn

per year, gain for the public accounts. Économie page (10 Oct. 2026): « économiser 5 milliards d’euros » [“save €5 billion”] for a package that also includes making non-contributory social benefits conditional, for all foreigners, on 5 years' residence, and the fight against fraud involving unaccompanied minors

Published costings

none

No external costing of this position recorded to date.

Our calculation

+€0.4bn

per year for the public accounts, saving, range +€0.2bn to +€0.7bn.

The calculation

  • Transformation into emergency medical aid (limited basket: emergencies, serious illnesses, pregnancy, vaccinations): Option costed by the source: a gain of €0.4bn (0.2 to 0.7) per year.

Assumption by the editors. Reading adopted, the same as for David Lisnard and Bruno Retailleau: AME is abolished and replaced by coverage of urgent care only (« aide médicale d'urgence » [“emergency medical aid”] option), here one emergency clinic per département; the specific cost of these clinics has no source.

Coefficient calculated by the editors from Sénat, commission des affaires sociales, L'Essentiel PLF 2026 « Santé » (avis Florence Lassarade): the position is marked as an assumption by the editors.

Figure announced by the candidate: no gap calculated: the announcement covers a different scope or a different year.

Current law, sources and limits of the cost schedule

Current law. AME (state medical aid; Code de l'action sociale et des familles, art. L251-1 et seq.): coverage of healthcare for irregular migrants resident in France for more than 3 months, subject to an income ceiling. Prior approval for certain scheduled care during the first 9 months. Actual spending of €1,386.8m in 2024 (+15.5%) and €1,385m forecast for 2025 (DSS), whereas the appropriations in the PLF 2026 are €1,208.3m. 461,833 beneficiaries at 31 March 2025. Spending split 61% hospital care and 39% community care.

Horizon. Full year 2032, current €bn, compared with current law

Limits. 2032 projection calculated by the editors: €1,385m in 2025 × (1+g)^7, with g = 3% (low), 4% (central, rate anticipated by the Senate for 2026) and 6% (high, average since 2009). Abolition: GROSS and static saving. It ignores the shift to urgent care (€132m in 2024, already partly borne by national health insurance), hospitals' unrecoverable debts and health effects. The Évin-Stefanini report (Dec. 2023) considers the AMU (emergency medical aid) « inappropriée » [“inappropriate”] and costs no saving. There is no official costing of the AMU. The range is constructed: the low end takes the order of magnitude of the Senate amendment (-€200m), the high end removes the whole share of outpatient care (39% × 1.82 ≈ €0.7bn), the central value is halfway. Voted appropriations underestimate actual spending every year: the State's debt to social security in respect of AME (state medical aid) would reach €362m to €428m at the end of 2025. The cost schedule therefore costs on actual spending, not on appropriations. The three options are mutually exclusive (overlaps declared).

  • Sénat, commission des affaires sociales, L'Essentiel PLF 2026 « Santé » (avis Florence Lassarade), 2025-12-03: « « Les dépenses d'AME ont progressé de 6 % par an en moyenne depuis 2009, et de 40 % entre 2021 et 2025. Alors que les crédits consacrés à l'AME resteraient plafonnés à 1 208,3 millions d'euros en 2026, les dépenses réelles d'AME ont atteint 1 387 millions d'euros en 2024 » ; « La direction de la sécurité sociale (DSS) estime ainsi que la dépense prévisionnelle s'établira à 1 385 millions d'euros pour l'exercice 2025 » ; « En 2026, une progression de 4 % est anticipée » ; « Les prestations hospitalières représentent 61 % de cette dépense » ; « un amendement minorant les crédits de l'AME de 200 millions d'euros » »
  • Sénat, rapport d'information n° 841 (2024-2025), Vincent Delahaye, commission des finances, sur l'aide médicale de l'État, 2025-07: « « le coût total réel de l'AME est de 1 386,8 millions d'euros, soit une hausse de 15,5 % des dépenses par rapport à 2023 » ; « l'État ne prend pas en charge l'intégralité de la dépense d'AME pour soins urgents, puisqu'il ne verse que 70 millions d'euros à la sécurité sociale sur un coût total de 132 millions d'euros » »

How to read these amounts. These are static costs and revenues, with no feedback effect, over a full year: nothing on growth, employment or the revenue that economic activity would gain or lose. A higher net cost does not on its own make a worse policy, nor net savings a better one: each programme rests on an economic model (demand-led stimulus, lower compulsory levies, consolidation of the public accounts…) that the cost schedule does not settle. GDP itself measures a volume of activity, not well-being or the usefulness of what is produced. Economic models and feedback effects.

This lever in the method · Costing for Nicolas Dupont-Aignan

  1. Debout la France, Notre projet : Immigration et assimilation (livret 2026-03-03). Read the programme page.

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